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Clinical Microbiology Reviews, January 2005, p. 133-146, Vol. 18, No. 1
0893-8512/05/$08.00+0     doi:10.1128/CMR.18.1.133-146.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

Options for Field Diagnosis of Human African Trypanosomiasis

François Chappuis,1,2* Louis Loutan,2 Pere Simarro,3 Veerle Lejon,4 and Philippe Büscher4

Médecins Sans Frontières, Swiss and French sections,1 Travel and Migration Medicine Unit, Geneva University Hospital, Geneva, Switzerland,2 World Health Organization, Yaoundé, Cameroon,3 Department of Parasitology, Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium4

Human African trypanosomiasis (HAT) due to Trypanosoma brucei gambiense or T. b. rhodesiense remains highly prevalent in several rural areas of sub-Saharan Africa and is lethal if left untreated. Therefore, accurate tools are absolutely required for field diagnosis. For T. b. gambiense HAT, highly sensitive tests are available for serological screening but the sensitivity of parasitological confirmatory tests remains insufficient and needs to be improved. Screening for T. b. rhodesiense infection still relies on clinical features in the absence of serological tests available for field use. Ongoing research is opening perspectives for a new generation of field diagnostics. Also essential for both forms of HAT is accurate determination of the disease stage because of the high toxicity of melarsoprol, the drug most widely used during the neurological stage of the illness. Recent studies have confirmed the high accuracy of raised immunoglobulin M levels in the cerebrospinal fluid for the staging of T. b. gambiense HAT, and a promising simple assay (LATEX/IgM) is being tested in the field. Apart from the urgent need for better tools for the field diagnosis of this neglected disease, improved access to diagnosis and treatment for the population at risk remains the greatest challenge for the coming years.

* Corresponding author. Mailing address: Travel and Migration Medicine Unit, Geneva University Hospital, 24 rue Micheli-du-Crest, 1211 Geneva 14, Switzerland. Phone: 41-22-3729620. Fax: 41-22-3729626. E-mail: francois.chappuis{at}hcuge.ch.

Clinical Microbiology Reviews, January 2005, p. 133-146, Vol. 18, No. 1
0893-8512/05/$08.00+0     doi:10.1128/CMR.18.1.133-146.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.



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